Fulcrum-bending像与伴发脊髓空洞或(和)Chiari畸形脊柱侧凸的手术治疗

Fulcrum-bending radiograph and surgical treatment of scoliosis associated with Chiari malformation and/or syringomyelia

[目的]探讨Fulcrum-bending(支点弯曲位)像对伴发Chiari畸形和(或)脊髓空洞的脊柱侧凸手术治疗的帮助及新思路,并分析手术疗效。[方法]18例伴发脊髓空洞和(或)Chiari畸形的脊柱侧凸患者的治疗方案分两组:(1)牵引后前后路联合脊柱侧凸矫形手术(6例):对脊柱侧凸有手术矫形指征、伴发无明显神经损害的Chiari畸形和(或)脊髓空洞者,先行Halo颅骨牵引,1周后行脊柱侧凸矫形手术;(2)直接行后路脊柱侧凸矫形手术(12例):术前拍Fulcrum-bending像,并根据其结果对脊柱侧凸进行矫形。[结果]6例牵引后手术患者Cobb’s角平均矫正率为61%;6例柔软型侧凸患者直接后路手术患者均未出现神经并发症,Cobb’s角平均矫正率为60%,且术前Fulcrum-bending像与术后Cobb’s角相接近;6例僵硬型侧凸患者中1例出现轻微神经损害情况,后逐渐恢复,Cobb’s角平均矫正率为52%,手术存在过度矫正。[结论]对无明显神经损害的伴发脊髓空洞或ChiariI型畸形的脊柱侧凸柔软患者,不必行术前牵引而直接行后路手术,且可以获得与牵引后前后路联合手术类似的矫形效果。

[Objective] To evaluate the value of Fulcrum-bending radiograph and new treatment strategy to the scoliosis with Chiari malformation and/or syringomyelia,and to analyze the effect of operation.[Methods]Eighteen cases suffering from scoliosis with Chiari malformation and/or syringomyelia were divided into 2 groups for surgical treatment.（1）Group 1：six cases had scoliosis with Chiari malformation and/or syringomyelia without obvious neurological impairment.Their scoliosis was corrected with anteroposterior instrumentation afer one week of Halo＇s traction.（2）Group 2：another 12 patients having similar scoliosis underwent posterior orthopedic operation according to the result of preoperative suboccipital Fulcrum-bending radiograph.[Results]In 6 patients who underwent opration after traction,the average frontal correction rate was 61%.In another 6 cases having soft scoliosis with only posterior operation,the average frontal correction rate was 60%,and the result of opration came close to the Fulcrum-bending radiograph＇s.But in 6 cases having rigid scoliosis with only posterior operation,the average frontal correction rate was 52%.One patient had nervous lesion and gradually recovered.There existed excessive rectification.[Conclusion]Patients with soft scoliosis with Chiari malformation and/or syringomyelia without obvious neurological impairment can be operated on according to Fulcrum-bending radiograph without preoperative traction,and the therapeutic effect is similar to classic operative result.